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Pediatric Coding Alert

Reader Question:

Complaint May Not Equal Final Diagnosis

Question: I have a new patient that is four days old presenting to our office with a chief complaint of jaundice. The pediatrician evaluated the patient and did not find any jaundice. He coded a 99203 with a diagnosis of V20.32. Should this be coded as a 99381 with the V20.32 or should we keep it the 99203 if documentation supports that high of a level? Kansas subscriber Answer: You can only report the new patient well visit code 99381 (Initial comprehensive preventive medicine evaluation and management...) if the physician did an initial physical exam with newborn anticipatory guidance and checked the birth history. If the doctor had already seen the patient in the hospital and then saw the patient again in the office to follow up on jaundice that he had diagnosed in the hospital, you should report 99213. You'd use the established patient code since the doctor already [...]